Needling the pain away

Don’t freak out if your physical therapist suggests sticking a needle into a problem spot

Michael Haylett of Health In Motion inspects a patient’s problem area, then places the super-fine needle into the muscle. The device he’s holding sends low-level electricity into the needle to increase its effect on the muscle and tissues.

Ask Susan Koehler what she thinks about dry needling and she will rave about it: “I recommend it to everybody.”

The 55-year-old is in good health overall but says she was experiencing some leg and back pain that she didn’t want to treat with prescription medication. “I am not into that, so I ended up going to a clinic who then suggested physical therapy."

Koehler found Ben Solheim, a physical therapist at Health In Motion in Wausau, who did some exercises on her lower back and calves in addition to other manual therapy techniques. Then Solheim suggested she try dry needling.

“I said, ‘Oh, no you don’t,’” says Koehler. “I thought it was like acupuncture, which I had never done, but Ben assured me that it was not.”

Well, it’s a little bit like acupuncture to the layman, in that a very fine filament is inserted into your body to illicit a response that helps your body heal itself.

“When he did the dry needling, it wasn’t the most comfortable thing. You don’t feel the poke but you do feel the wiggle [of the needle],” Koehler explains.

In the first 24 hours post dry needling, Koehler says she experienced a little aching. “But then the pain in my legs and back just kind of melted away. It just went away.” Any discomfort she feels during the needling is more than paid off by the relief, Koehler says. “I wouldn’t go back if I didn’t think it was worth it.”

Dry needling is a medical practice that uses a fine, sterile monofilament needle inserted into a muscle to help relieve pain and mechanically “reset” the muscle. Because no fluid is pushed into the muscle, it’s called dry needling rather than a “wet” injection, says Solheim.

"Once inserted into the muscle, the needle reduces or eliminates the spontaneous electrical activity (SEA) present in knotted muscles," he says. "This creates a 'twitch response' in the muscle and can be felt as a short 'jump' in the muscle and indicates the tissue has been reset."

Your own nervous system response, the SEA, keeps a knot active, so deactivating this is important for success, he says. Since knots often afflict multiple areas within the same muscle that need to be reset, the filament is moved around within the muscle. That’s the “wiggle” Koehler refers to, says Solheim.

Dry needling is one method used by St. Joseph’s University Medical Center in Paterson, N.J., to reduce by more than half its emergency room use of opioid pain killers, according to a Feb. 20 story by National Public Radio.

While dry needling in many patients does help alleviate pain and discomfort in muscles, the goal should be to fix the overarching problem. Dry needling is just one component of a care plan, says Solheim.

In other words, you shouldn’t go to a provider and just ask for a dry needling session as you would with acupuncture or massage.

And while many people may think dry needling is the same as acupuncture, that’s not the case, says Solheim. “The practice theory use is different,” he says. "The only similarity between the two is a shared tool—a fine filament. The job being performed is different. Dry needling essentially treats musculoskeletal pain while acupuncture aims to influence energy or meridians.”

Dry needling has been used in the United States for about 40 years, says Solheim. It was first developed by a Czech researcher named Karl Lewett in 1979 who found that inserting a needle into trigger points was just as effective as injecting solutions such as lidocaine or cortisone.

Dry needling can be used on muscle trigger points, which are tight fibers that feel like a knot, create pain in other areas of the body, and create poor mobility, says Solheim. Since physical therapists know the intricacies of human anatomy, he says, they’re able to treat almost any muscle on the body, if they’re fully certified and trained in dry needling, he says.

Solheim says most patients do well with dry needling, but it’s not used on those with an infection, who have had recent surgery, have active cancer, or are pregnant. "This is a safe, very effective technique when used with a physical therapy plan of care."

Jamie Wendorski, a physical therapist at Quad Med, an on-site clinic at Greenheck Corp., says she started using dry needling on her patients about two years ago. “I do it pretty regularly,” she says.

Wendorski tends to treat the upper trapezius, neck and shoulder region the most. “It is something we treat quite frequently,” she says. “A lot of people have pain and discomfort in that region and needling just tends to help that area for the tension and tightness.”

Treating headaches, too

Patients with tension headaches and proven trigger points in their head and neck area respond well to dry needling, says Dr. Jan Bublik from Dental Visions in Weston.

“In my practice we deal with tension headaches and pain commonly referred as a TMJ [temporomandibular joint disorder] headache or TMJ Pain. Dry needling, along with other forms of physical therapy, is an excellent treatment for muscular TMJ disorders, he says.

“When people suffer from myofascial pain and with that headaches caused by tension within muscles in the back of the head and neck, we can identify such headaches,” Bublik says.

Along with splint therapy to lessen the effect of jaw clenching, trigger point injections and trigger point dry needling are great treatments, he says. “It’s all about proper restoration of neck muscles, which support your head. If they’re constantly “cramped” they can’t function properly,” says Bublik.

“What do you do when you have a cramp?” says Bublik. “You stretch, or push on it hard or massage it. When you have a cramp in your chewing muscles, or in the region behind your head, you call it a headache.”

“Certain areas of the musculature (trigger points) are so hard in fact, that they exhibit constant cramping. These muscular knots must be ‘destroyed’ to allow the muscle to function well again.” Dry needling can help restore the function of those muscles, he says.

His office refers about a dozen patients a month for different forms of physical therapy for TMJ, some of which will include dry needling.

“Dry needling isn’t a treatment by itself in our experience,” says Bublik. “It’s excellent in conjunction with other forms of physical therapy and neuromuscular re-education.”